Treating Arthritis in Growing Bodies

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Five-year-old Katie Tortorice of Carmel, Ind., figures out all her parents' tricks for getting her to take medicine. "Now she refuses to drink her milk," said Kelly Tortorice, Katie's mother. "She's figured out that we've been hiding her medicine in there."

The medicine that Katie so skillfully tries to avoid means the difference between a once-devastating and crippling disease and a simple nuisance disease - juvenile rheumatoid arthritis (JRA). Today, if treated properly with medications and physical therapy, children with JRA are expected to recover completely without any of the deformities and loss of function that afflicted these patients until recently.

Two-and-a-half years ago, the Tortorice family visited the pediatrician because Katie developed a mysterious high fever and a swollen ankle. They were referred to the department of orthopedics at Riley Hospital for Children. Once doctors ruled out orthopedic conditions, the Tortorices met Dr. Susan Ballinger, who at that time was one of only three pediatric rheumatologists in Indiana.

Dr. Ballinger diagnosed Katie with polyarticular JRA. A disease that affects approximately 1,500 Hoosier children, JRA causes inflamed, swollen joints that are often stiff and painful. The peak onset age is 2 to 3 years old, and the condition tends to be more prevalent in girls.

The three types of JRA differ primarily by the number of joints affected. Pauciarticular JRA - the most common form - affects up to four joints. Polyarticular JRA affects more than four joints. Systemic JRA manifests itself with whole-body symptoms, high fever spikes, generalized pain all over the body and, occasionally, a rash. Systemic JRA is the most serious but least common form.

"Most children outgrow JRA," said Dr. Suzanne Bowyer, director of Riley's section of pediatric rheumatology. "If left untreated, when the child outgrows the disease he or she is left with contractures and permanent joint damage or muscle loss. The good news is most cases are successfully treated through medication combined with proper therapy." Dozens of different types of arthritis can affect children. At times, it is difficult to distinguish between these joint problems. For this reason, JRA often is difficult to diagnose.

"Seventy-five percent of the new patients we see do not have JRA. In most cases, they may have easily treatable muscular-skeletal conditions," said Dr. Bowyer. "When the diagnosis is something like JRA, Riley takes a holistic approach to treating children and families through the combined efforts of social workers, physical/occupational therapists, doctors and nurses."

The Tortorice family visits Riley every three months. "We've been so lucky. You'd never know that Katie has arthritis," said Tortorice. "We've always known about Riley Hospital but never thought we'd need it. Now we're so thankful that Riley is nearby. And Katie loves Dr. Ballinger."

Following the philosophy that children aren't small adults, Rile's pediatric rheumatologists know the outcome of the disease and its treatment options differ from adult arthritis sufferers. These pediatric specialists are experienced in anticipating both physical and social problems with their growing patients, and helping families cope. "I'm a pediatrician first and foremost," said Dr. Ballinger. "I know what a normal kid is like. I expect a kid to be a kid."

With new drugs and more aggressive treatments, fewer and fewer children come through JRA with permanent or temporary disability. This once crippling condition has been rendered a nearly silent disease.

[Keywords: Rheumatology]

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